VA Health Benefits Application Form (10-10EZ)

The VA Form 10-10EZ is the form used to apply for health benefits at VA medical facilities. Submission of this application will provide us with the information we need to begin the enrollment process for you. When needed, a veteran’s benefits counselor will follow up to assist you in completing the enrollment process.

You can access the form by creating an account or logging into the VONAPP page at:, then select the the from the form list and fill it out online.

10-10EZ Form

  • Call the Help Desk 855-574-7286 Monday through Friday, 8:00 a.m. to 8:00 p.m. (ET) to get help with your application.
  • Mail in your application. You can download, print, and fill out the 10-10EZ, then send it to this address:

Health Eligibility Center

2957 Clairmont Rd., Suite 200

Atlanta, GA 30329

What information will you need to complete the 10-10EZ?

  • Your most recent tax return
  • Social security numbers for yourself and your dependents
  • Account numbers for any current insurance programs in which you are already enrolled

All form pages can be downloaded on the download dl-icon button at the bottom of the page or made bigger with the expand expand button on the bottom of the page as well.